Medical Responses To Catastrophic Events In The U.S, Israel and Abroad

1. Medical Responses To Catastrophic Events In The U.S, Israel and Abroad Presented to the Scripps health And the U.S. Mexican border Health Commission June 15, 2005 By Dr. Boaz Tadmor

2. Modes Of Responses • Passive- follow the events without self initiative • Active- take the initiative after the events and prevent deterioration • Proactive- prevention and mitigation prior to events.

3. Flow of stages of Responses • Prevention- at all times. • Hyper-acute phase- Immediate Response : first 24 hours • Acute phase- primary response : 24-96 hours post event • Continuous phase- 96 hours- days, weeks, months • Recovery phase- Resuming normal life

4. Web Of Responses • w.w.w.w • Who—When—With What—Why

5. individual familial Community First responders county state Federal IR AR Prevention PR Recovery Weeks 96H 24H Gant Chart Of Responses

6. “ need to know” Areas of responses • non specific knowledge, basic survival skills, - individual based • specific knowledge- individual, familial, community-web, risk communication • expert knowledge- community, local, state, federal- agency based • leadership skills and knowledge – at all levels.

7. Goals of Responses in Disaster • Prevent and Reduce as much as possible all types of damages. (human life, injuries-mental and physical, societal, economical, technological) BY • Synergistic interaction and collaboration through constant feedback mechanism • Look where are your relative advantages/ disadvantages and behave accordingly.

8. Goals of the medical system • Providing timely and needed care at all levels to all , at all times by all means.

9. Different, Additional concerns in Disasters • limitation of specific knowledge • limitation of needed resources • limitation of physical space: surge capacity • role of primary physician, HMO’s , hospitals • define orders of priority of care- “Damage Control” mode

10. Different, Additional concerns in Disasters • Define level and type of care for each level of medical system • Delegate authority • Added responsibility • Decision making without “ evidence based medicine” • Different network of care and information • Reserve medical corps, NDMS, deployment, public health, web info

11. Role of the physician in times of Disaster • Hub of information- bilateral feed back mechanism • Reliable and knowledgeable • Has official authority and responsibility • Leader in the community • Specific different role in specific situation • New desired skills. • Part of a new team • Delegate authority • Learning and implementing capabilities.

12. Generic U.S.A mode of responding to Disaster • Individual-community-local (county)-state-federal • No involvement of the army resources or national guard. • Minimal involvement of the private sector • No “ ONE SHOP STOP” for decisions • Long and convoluted lines of communication. • Different lines and modes of responsibility • “Babel -Tower” of integration and collaboration

13. put some web sites: www.fema.gov • Are you ready, National Response Plan

14. U.S.A. Medical model of Responding • Individual-self care, HMO’s, primary physician, hospital • Community and Local- DOH, Hospitals, First Responders, Academia • State- DOD, Hospitals, HMO’s, specific units (DMAT, S&R, Epi), Academia • Federal- All of the above, DHHS( CDC, NIH, NDMS, National Stockpile), HLS, Different agencies in different ministries.

15. continue-13 • Hierarchy of knowledge, expertise and resources • Different arms, different engagements, different language, different expertise, different leadership

16. Main Scenarios/Threat Assessments(1 of 2) • Mega terror events • Toxicological events • Specific chemical events • Bioterrorism events • Mass vaccinations • Primary and secondary deployment • Antibiotic distribution

17. Main Scenarios/Threat Assessments(2 of 2) • Public health disaster and preparedness issues • Principles of debriefing • Mental immunity issues • Rehabilitation issues • Quality control/evaluation issues • Special population issues

18. Integrated Working Milieu Israeli Police Home Front Command Medical Corps Military clinics Local Municipalities Combat medical forces HFC HQ HFC Regional commands • MDA • Integrated Hospital • organs • Representative at the • Supreme Health Authority • Assistance to • Health Advisory • Committees Logistic& Technological HQ Unique forces • Surg. General HQ • Part of the Supreme • Health Authority • Authority for • deployed Medical • personnel Primary care clinics Professional committees Professional Advisory Secondary deployment international assistance Integrated HQ at war time Blood donation at war time Instruction and guidance for medical forces Members of the Supreme Health Authority Medical forces as integrated hospital organs National medical forces MDA personnel National Medical forces Medical assistance Guidance Aviational evacuation Level A Medical Companies Ministry of Health

19. Responsibility and Preparedness-Medical Department-HFC REHABILITATION ALERT Active Defense Passive Defense+ Treatment and Evacuation Preparedness and readiness Siren Back to Routine • Individual • Community • Medical center Ministerial offices Surg. Gen. HQ Medical Company-Level A Medical Company-Level B Medical Center Primary care clinics Physical Protection Medical Protection Illness surveillance Public knowledge R&D International cooperation MOH Committees Assessment of Special Population physical protection needs Rehabilitation Overseas cooperation Continued surveillance improvement according to the experience gained Evacuation/quarantine in the affected area Secondary deployment of casualties Blood Donation Hospital assistance life saving integrated work with national HQ Antibiotics and Vaccinations Public information centers 3

20. Responsibility of the Citizens • Understanding the threat • Motivation to collaborate with authorities • Suspicion and possible alarm • Surveillance • Isolation • Protection • Treatment • Follow up • Reporting

21. Civilian Population Responsibility

22. Overall Responsibility: Treatment and Follow Up

23. Responsibilities of Healthcare Agencies and Professionals

24. Points of difference (1) • Characterization of the threat • Type, kind, timeline, perspective • Size and diversity of agencies, organizations, academia, government • Individuals’ background • Military-civilian relationship

25. Points of difference (2) • Command and control systems • Resources: workforce, logistics, money • Education • Training • Mental and child consideration • Risk communication and the media • Synergy of first responders • Academia • Leadership perspective

26. Generic mutual concerns • Leadership and decision making • Synergy between first responders • Risk communication • Individual based responsibilities • Resiliency • Training and drilling • Academic involvement

27. Relative Advantages:Israel • Resiliency: individual, community • Hospital readiness and preparedness • Synergy of first responders • Military-civilian collaboration • Short lines of communication for command and control • Motivation to share experience and knowledge

28. Relative Advantages:United States • Diversity: • Academia • Local, state, and federal agencies and organizations • Excellent brainstorming • Media and technological capabilities • International collaboration • Scientific excellence • Resources

29. Collaboration • Practical knowledge and experience • Scientific knowledge and innovation • Sharing and mutual involvement and understanding • Create the cutting edge of understanding preparedness, mitigation, practicability and recovery